Gallbladder seems fine but PCP recommends removal

[misha50]

Had a full GI work up: CT scan, Hida scab, ultrasound, endoscopy, blood and stool tests.  A few years ago I also had an endoscopy, colonoscopy, x-rays, and blood and stool tests.  Results of all the tests do not show any problems with my gallbladder, and also no gallstones.  There is some family history of gallbladder issues.

I have acid reflux for at least the past few years and, per my GI at the time, slow motility in my digestive tract.  Per my current GI I may have IBS also.  Most of my symptons were diarrhea, stomach aches/discomfort, and soft and black stools.  Prilosec has made these symptons bearable and has helped relieved them to some degree, however still have some of the above symptoms and gassiness.  In truth, I never really felt that I had classic traditional heartburn or had problems eating certain foods, such as I could eat spicy foods and not have much change in my symptoms.

However,  in the past year I have developed additional painful symptoms:
Alternating pain between my right chest muscle and right under my right rib, like a throbbing or someone grabbing me under the rib - this initially started off as pain in my right upper back, but now it's rare to have the pain in the back.  The pain definitely tends to happen after eating, but also when laying down to sleep and when waking up in the morning.  Pain killers, such as Advil and Vicodin do almost nothing to relieve the pain, however once I tried Vicoprofen and it helped a little, but this is a very potent drug and it felt very addictive as I enjoyed its effect on me, so this drug is out.  I also have nausea, a bitter bile taste in my mouth, a feeling of fullness due to the nausea, some heartburn.  Fatty/Oily foods tend to inflame the pain the worst, but eating in general tends to aggravate it.  The pain is debilitating as I can't concentrate, am ultra sensitive to any noise or stimuli, and in general am not able to function.

My PCP says I have classic gallbladder symptoms and wants to remove the gallbladder.  A GI and a surgeon that removes gallbladders will remove the gallbladder if I insist as I'm at my wit's end, but they think it could be musculo-skeletal, which my PCP says doesn't make sense as I get the pain after eating.  After discussing this with the GI and surgeon, they agree that musculo-skeletal doesn't appear to make sense either.

I will be seeing another GI for a second opinion, but at this point I'm ready/willing to have gallbladder removal surgery.  Thoughts or suggestions on this?  Thanks so much!

[AlanPi]

Hi Cheri70, can you elaborate on why the Dr's say looking further is almost impossible after GB removal?  I have a HIDA ejection fraction of 7%, but no stones under ultrasound nor CT. I am also scheduled to have my gb removed...  I have also heard others who have pain on the left but got their gb removed, and continued to have the same symptoms.

[boron]

All investigations you've had, were to check only gallbladder. If even your HIDA scan was OK (what % was it?), then there's really a question, if it is gallbladder. Your symptoms may all arise from biliary duct - in this case removing of the gallbladder wouldn't help.

I would recommend you have MRCP before surgery. After gallbladder removal, constant diarrhea may be a problem, since bile is flowing into intestine all the time, and because it can't be all re-absorbed in the small intestine, it reaches the colon where it triggers diarrhea.

[misha50]

The surgeon and pcp don't feel that MRCP is warranted before surgery, so I guess I'm kind of stuck in the meantime.  I don't know what % my HIDA scan was, but I can inquire as supposedly it was OK.  The surgeon and pcp told me that 50% of cases similar to mine resolve issues.  As I have trouble functioning during day, sleeping, staying asleep, I'm willing to go ahead and try their recommendation.

[boron]

Have you tried low-fat diet?

[Cheri70]

The drs didn't say it was impossible, I'm saying it's almost impossible to get them to see why I am still in pain.  First it was "it takes time to heal" and now it's "we aren't seeing anything - maybe you are constipated" (??), however they hadn't really tested for anything either.  I just had an MRCP on Saturday and I await the results.

If 50% get better, then 50% get worse. Post surgery I had a good 5 months of pain so bad I could not function and at that time doctors telling me to deal with it.  It was way worse than prior to surgery.  Now I am finally back to the way I was prior to surgery, so "back to where I started", although now I also have upper left/center pressure pain.  

I wouldn't remove my gallbladder without at least knowing my HIDA scan results.  Anything over 35% means it's working fine.  I also question removing a gallbladder that does not have stones.  I wish I had listened to boards like this before surgery, I'd be less doctor bills, less scars and less pain.

[misha50]

I've been eating pretty healthy for awhile now, I'm guessing a low-fat diet as I've been avoiding fatty and oily foods, sauces, etc.  In addition, with my GERD, I try to eat bland food.  I admit that on occasion I eat a little something sweet, but it's very little and very rare, and symptons do get somewhat worse, but life without a little sweet now and then is not much of a life IMHO.  However, regardless of the foods that I eat, the pain and discomfort is pretty regular and constant: right abdomen below ribs and right chest muscle - the muscle tends to get worse when I turn and when I lie down.